tv United Nations 21st Century LINKTV November 12, 2013 7:30pm-8:01pm PST
sweet. whew! p-l-a-y! play! there are lots of great play ideas online. narrator: cancer, the number two killer in the united states. but, over the last ten years, death rates from cancer have been decreasing. today, more than half of all americans with cancer are being cured. and experts now believe that we are on the verge of important new breakthroughs in the war against cancer.
people who have been diagnosed with cancer are often overwhelmed by the medical decisions that need to be made... in what seems like a relatively short period of time. cindy lauren, an avowed health enthusiast, was only 36 years old when she was diagnosed with stage iii lobular breast cancer. cindy: i was very unprepared. i didn't know the vocabulary. i didn't know the treatment protocols. at the same time, i had to deal with being stunned and afraid, and i had to learn, so i could make the best choices for myself. should i have a mastectomy or lumpectomy and radiation?
should i have chemo, and how aggressive chemo? i think in many ways, in cancer treatment we're ahead of other diseases that are treated and studied. because when i, for instance, counsel a woman who's newly diagnosed with breast cancer, i'm able to pull off from the literature, from studies, that have just been completed or historic studies, statistics that can give them a very accurate appraisal of their likely benefit or their risks for taking certain treatments. and there are very, very few other kinds of diseases where we have that kind of information available. nowadays, treatments have changed a lot, and one of the things that have changed about it is that cancer has become more of a chronic illness than it ever was. and, as a result of that, people live with cancer over a long period of time which means that they may have many different kinds of treatments from surgery, radiation, experimental kinds of treatments
and it may become an integrated part of their life. surgery, chemotherapy and radiation... still today, the principle forms of cancer treatment. during surgery, physicians remove a localized cancer... cutting it away from healthy tissue. since microscopic pieces of cancerous tissues are hard to detect, the surgeon usually removes tissue beyond the obvious cancer to increase the chances that all the malignant cells are removed. cindy: if i jokingly say that surgery is the easiest part of it, it's still hard on your body. i had three surgeries. radiation every day for eight weeks. go to the hospital... get tired. chemo for seven months, and everything that brings. i don't think you can go through anything like that without it having a very profound effect on your life.
chemotherapy is used most often when cancer has spread to various regions of the body. patients are given anticancer drugs which destroy the cancer cells, or inhibit their ability to reproduce. because of the toxicity of the drugs, patients may experience side effects. cindy: suddenly my body was called upon to deal with drugs that were going to kill something that wanted to kill me. i fought pretty hard, but eventually i had to come to the conclusion that i was not made of iron. i was made of some cells, and some of those were a little sensitive to... toxic stuff. but, it was really tough for me. i lost about twenty-five pounds. losing my hair was more traumatic than i could have ever conceptualized. radiation therapy is also used to treat localized cancers...
alone or in conjunction with surgery and chemotherapy. concentrated doses of high-energy particles target the cancerous tissue... killing malignant cells, and stopping their spread. healthy tissues nearby receive only slight doses of radiation, and generally recover quickly. this is particularly true when proton therapy is used. because the stream of positively-charged, subatomic particles can be focused more precisely, there is little damage to surrounding cells. still another approach is to implant tiny radioactive beads within the malignant tissue for several weeks, and then remove them. compared to chemo, everyone sort of feels that radiation is a walk in the park and most of the time, that's true. i found radiation was a pain in the butt
because you have to go to the hospital every day, five days a week. you have to go down there, it really doesn't take very long but if somebody's late, if the machine has to cool down, so you can't really gauge your time. it made me really tired, and it... for me, i got a third degree burn underneath my breast where i guess one or two beams intersected. i had an open wound. that burn has still been the single most painful experience i've ever had in my life. these more traditional forms of cancer treatment are not the only options to be considered. dr. john glaspy: there are many instances where cancers don't need treatment, where we can just watch... and because we know the natural history of the disease, we know that you don't need treatment right now, or that treatment won't help you right now. doing no specific therapy is an option that ought to be talked about with many kinds of cancers
that we deal with. second on the list would be good, meticulous attention to non-cancer medical care: management of pain, management of fatigue which is a huge problem for cancer patients, and limits the quality of their remaining lives -- and for them, and for their families. we're just now figuring that out, en though the patients have been telling it to us for a long time. cindy: i was tired. i was stunned at how things i used to te for granted.ere difficult. it's hard to get across a crosswalk, when just as you get two feet into it, the "don't walk" thing starts blinking, and you're like, "that's a mile away." "i can't go any faster." or, i'd go for a bike ride and i'd feel pretty good, but all of a sudden, i'd be too tired... i'd have to stop and rest before i went home. that's probably one of the single, most profounlecies
that any -- i think, any cancer treatment probably leaves you, is you're just -- it takes a tremendous amount of energy. dr. glaspy: treating low blood oxygen levels with oxygen, making sure that people are as nourished as they can be, making sure pain is well-controlled. all of those are part of what we have to offer. good, general medical care. a lot of times, these things get -- don't get talked about, or don't get focused upon, and they are extremely important parts of the armamentarium. what you have run in this lane, here... is the sample from the normal cells? - and this would be the tumor sample? - that's right. in the last few years, a new breed of treatment has emerged in the fight against cancer -- the manipulation of the body's own immune system to rid the body of its cancer. the umbrella term for these new, and generally experimental methods, is "biomodulation". one such treatment includes the use of gene therapy.
dr. glaspy: there's tremendous progress being made now with gene therapy, which has tremendous technical limitations associated with it, that are just now being overcome by the engineers who work on these things. ovarian cancer is a particularly promising target. when traditional treatment methods failed to stop the advance of ovarian cancer, doreen gerber became part of an experimental study at ucla's jonsson cancer center. in this study, doctors are replacing a defective gene that is thought to cause ovarn cancer in aut half of all the women with the disease. the study is designed to test this new gene therapy technology head to head against standard therapy. it's the first study of its kind in ovarian cancer. healthy genetic material is injected directly into the abdomen, carried into the system by a disarmed cold virus.
side effects appear to be minimal. doreen gerber, patient: i certainly feel so much better after these treatments. i didn't lose all my hair. i'm not bloated any more. so far, the results of this experimental genetic study are encouraging. dr. pegram: we see no evidence of recurrence of the ovarian cancer following her gene therapy treatment. but patients will continue to be monitored to determine the long-term results of this new treatment technology. another class of drugs, known as angiogenesis-inhibiting drugs, also hold great promise in the ongoing battle with cancer. these drugs cut off the blood supply to tumors, depriving them of the nourishment necessary for growth. dr. glaspy: the angiogenesis-inhibiting drugs... there are a lot of them out there. some of them have exciting pre-clinical data.
they're in early clinical trials, and they may sort of change this gameboard a lot for us. then we... get into the realm of experimental treatments, drugs like herceptin, which... attack something that's different about a cancer cell, and make that cell either stop growing, or make it more sensitive to treatment with the other modalities. in 1986, the scientific community learned that a gene involved in regulating cell growth had been discovered -- her2/neu. about the same time, dr. dennis slamon and his team of researchers were extraing dna from discarded cancer tissue, looking for genetic alterations that might be linked to the disease. these are the pieces of the breast tumors. dr. slamon: about 30% of patients who had breast cancer had this particular gene altered,
and we recognized that it wasn't something inherited, but it was something that was occurring during the life of the individuals. in a normal cell, they conol the production of protein found on a cell's surface that acts like an antenna, receiving signals to grow. the gene mutates, and multiple copies are made, the additional protein that is produced calls for too much cl growth. this results in an aggressive cance that grows and quickly spreads. but what if researchers could find an antibody that would inhibit the growth of the her2/neu gene? that was slamon's challenge. and the result, after a decade of work, is herceptin -- the first biological therapy that attacks cancer at its genetic roots. dr. slamon: what the antibody is able to do, is attach to this protein,
and actually block or change that signaling, so that the signals that tell the cell to grow don't work. traditionally what we treat cancer with are nonspecific toxins -- nonspecific therapies like chemotherapy, or radiation therapy, which kills bad cells and good cells, hoping to kill more bad than good when we use them. if we can identify what's broken in a cell that's making a malignant cell from a normal cell, it has always been hoped that we could target that. in clinical trials involving 940 women with advanced breast cancer, herceptin produced dramatic results. for some patients, tumors disappeared. in others, herceptin stopped progression of the disease. when combined with chemotherapy, patients had a 50% better response rate than patients using chemotherapy alone. but as impressive as these results are, herceptin is not a cure for breast cancer.
of the 180,000 cases of breast cancer diagnosed each year, just 60,000 involve the her2/neu gene. dr. slamon: and it'not effective even forll of those patients. so, we're working on two problems in parallel. number one -- those patients who have the alteration who should respond -- why aren't they responding? what can we do to make them respond? number two -- those patients who don't have the alteration, what alterations do their tumor cells have that we might be able to target? before herceptin or any other drug is approved for use by the food and drug administration, it must be rigorously tested... not only in the laboratory, but with patients. research conducted by doing clinical trials that involve patients with cancer have made extraordinary contributions to our treatment of cancer. fifty years ago, virtually all children with cancer died. now, 75 or 80%...
basically are cured of their cancer, live more than five to ten years, and usually live a normal life span. that's all due to the fact that virtually every child with cancer is enrolled in a clinical trial. dr. ganz: i remember some young men, that when i first trained, with testicular cancer -- a rare cancer, but very aggressive. and they would routinely be dying on our wards with advanced tumors. and, again, being so close in age to them, it was a very tragic situation. and all of a sudden, a new drug came on the scene. it was called cisplatinum, and it had actually been tested in some experimental trials where they took all sorts of patients with advanced cancer, and, lo and behold, a few of them with advanced testicular cancer responded. and then, before we knew it, it was incorporated into a standard treatment regimen. and, all of a sudden, we were curing this disease. some critics denounce clinical trials on the basis of their cost, the potential risk to participants, and the conflict of interest that may exist
between drug companies and researchers. still, many scientists believe that such trials are essential. dr. glaspy: clinical trials are the gold standard for changing disease rates or outcomes with disease. these things are usually heralded by one thing that works, and causes a lot of attention, but has side effects, or isn't fully perfect. and i think that vanguard has been that the story with tamoxifen and breast cancer prevention. that was very important. it was the first time we've ever given patients a pill that lowered their cancer risk. in this case, it was breast cancer, and it lowered risk by 50%. the breast cancer prevention trial -- the first of its kind in the united states -- was designed to see whether the drug tamoxifen prevents breast cancer in women who are at high risk of developing the disease.
the 13,000 women who participated in the study were randomly assigned to receive tamoxifen or a placebo. tamoxifen is a hormone. it acts as an estrogen in some tissue, and an anti-estrogen in another. it's an anti-estrogen in the breast. it blocks the binding of estrogen to estrogen receptors in the breast, therefore, it reduces the proliferation of cells in the breast, so it reduces the likelihood of cell turnover, and the likelihood of cancer either progressing, or actually developing. but if it is an estrogen in other tissues... it could cause endometrial cancer. debbie, here's a heartbeat that is low. it needs to be taken care of. keep an eye on her, because she's short of breath. dr. bernstein: the risk of dying from endometrial cancer, or even developing endometrial cancer, is far lower ever... than the risk of getting either a second breast cancer,
or developing breast cancer. so we then want to weigh the risks and the benefits. tamoxifen did increase the women's chances of three rare but life-threatening health problems... one of which was endometrial cancer. but the incidence of this occuring was quite small. dr. ganz: there's still critics... who are concerned about the drug, and... they can certainly raise their questions. but i think there's no question that we looked at the safety and efficacy of tamoxifen, and found that in fact, it did reduce the risk of breast cancer. women may take that information now, and decide that they want to be treated, or they may say, "gee, you know... it's still uncertain, and i don't want to do that." the challenges of treatment, the uncertainties of the disease, are difficult for any cancer patient to endure. ms. coscarelli: cancer, because it's a life threatening illness, comes with it a whole host of psychological issues that are presented or existential issues that come up
as a result of a cancer diagnosis. and i think that because of that, and because of the nature of it, and the nature of the difficult treatment that patients have to undergo in order to survive their cancer, that there are many concerns and problems that have to be dealt with. so, how does one react to that? well, people react to that in a variety of ways, and no two people are exactly alike. ann: vulnerability was the only choice i had. i didn't have a choice to be tough. but then, for other people, a certain amount of denial and going, "well, this is going to work." there are different human beings, and there are different paths through this. some cancer patients have found that it helps to talk with others who are battling the disease. pam: the support group has been wonderful. not only the information, but the sharing of the fears... ms. coscarelli: groups can be helpful at almost any phase. and, in fact, we have groups
for different phases of the cancer. we try to keep people who are newly diagnosed together. we have groups for people who are -- after the cancer diagnosis, no longer on treatment -- who are dealing with kind of the reentry back into the world of work and living, and still dealing with the changes that have come about in them. i shared it with everybody, and i had a lot of support from friends, and with the groups. it's been great. we also have groups for patients who recur. and that is the reality of cancer... that, for a certain percentage of patients, their disease will recur. cindy: i was very reluctant to go to any kind of a support group because i was one of the tough ones. but the thing that i liked, aside from all the jokes, was that if i did get to that scary place where i might cry, or i might demonstrate my vulnerability, sobody who's sitting next to me totally understood and wasn't going to say,
h, you're going to be fine." if i hear that one more time, that's one time too many. "uh, yeah, thank you, that's great, but right now, i don't feel like that, and i want someone who understands i don't need to hear that." ann: i all of a sudden i started going for very long walks, and spending a lot of time trying to run away from this whole horrible, horrible thing. you tell yourself you're supposed to be tough. you're supposed to tough this out. you're supposed to handle it well, whatever that possibly means. and it was quite clear to me that was not in the cards. as you say, for me, at least... that's e of the things that a group does... is that it tells you that "no" covers a wide spectrum. and for me, at least, "normal" meant being incredibly vulnerable, and reaching out to a group, reaching out to my husband, and it changed my life in so many ways. cindy: one of my favorite things someone says is...
"well, if that happened to me, i would just die." i go, "you know... you don't get to die." you have to wake up every morning and go, "okay, today i have, doctor appointment, radiation, blah, blah, blah." and you don't get to hide from it. you can take walks all day long, but it's still there when you come home. ms. coscarelli: it's not just the disease that you're treating. you're treating a whole person. and that's the orientation that we've taken... how do we treat that whole person, because in reality, the disease is a small part of it. it's the repercussions of the disease that someone has to live with, and those repercussions are on the family, on the individual and their psychological status. dr. ganz: cancer is a family disease. there's no way you can exclude the family from this, and it's a rare patient who won't tell anyone about their diagnosis. occasionally it happens, but, most of the time, everyone -- the co-workers, the extended family, everyone knows about what's going on, because people do feel more comfortable about being open.
but it also serves another important point, in that you need all the help you can get. our treatments are so complex. if somebody's living in a large city, and they want to go to a specialized medical center such as ours, they may have to travel twenty or thirty miles. well, you can't go back and forth if you've had a chemotherapy treatment on your own. somebody has to take you. so the family is critical. cindy: i hated chemo. it hurt me. it made me sick. i really was not thrilled with my oncologist, and i just remember saying one day, "i'm just not going to go. nobody can make me go. i don't like this," and through a series of misadventures, my little sister, who i think is t only person on the planet who's tougher than i am, showed up at my doorstep, and said, "we are going to chemo now." and basilly hauled me by the scruff of my neck do there. and it was an incredibly great thing for her to have done. dr. ganz: patients need someone...
who they can share their fears and their concerns with. and they often do this with a close friend, or a family member, and often that person becomes a real kind of sounding board for testing out... "am i being overly concerned about this?", or... "should i be worrying about that?" ms. coscarelli: and you can't forget the interaction between people because you're a worker, you're a parent, you're a mother, you're a sister, you're a friend. and so, in all of those things, those relationships become affected as people react to the diagnosis, and also as they attempt to interact with you and share in that experience. even young children feel the threat of cancer. pam: and it took for my youngest several years before she was ready to tell me how frightened she was that she was going to lose a mother... when she was... seven. it was very frightening,
and she did come up with that several years later. so she really could remember that fear...? oh, absolutely. but was probably too afraid to express it at the time. ( sighing ) to me. i don't know if she did to other people. i know it was very nice -- she went to a very large public school, and she found teachers that had been her own teacher, her friends, teachers of her older sister's that she didn't even know. and she would be telling them about my blood count, and working everything out, and i was very appreciative for that. spread the roots, so they fan out, instead of spiralling around in a ball. ann: my daughter keeps saying, "why do you have to know... and think about this all the time? why can't they put it all in one little package so that it can go away?" and there are bad things about that. and the fear is always -- it's part of my life now.
but there have been... partly through the work that i've done with the group, there have been such good things. i think we all went through a process of winnowing our lives. i think this is something that everybody did that i saw. we all started taking a look at our lives and going, "all right. what's important?" that is not dead. it's a bud. ( laughing ) this is a de-head. ms. coscarelli: so you don't know exactly what the factors are... in terms of the education that's provided, the ability to share one's feelings, and how one goes about living one's life. and you all heard that those women in there were very invested in life. they were invested in living, and they were invested in taking this cancer experience, which is extraordinarily difficult, and they wanted to turn it into something good.
and they did. and you have to believe somewhat in the power of that, and how that can be healing for the soul, and healing for the body. cindy: i've put a lot of energy into being a counselor for the american cancer society, because i think i understand... that combination of shock and dismay, and confusion that somebody has when they're first diagnosed. and i learned, if nothing else... how to listen and be there. ann: i think one of the things that happened with me, is that cancer became rephrased into something that was normal. "okay, you are alive, you have cancer, you have normal feelings. you are a normal human being, and you are... you continue." cindy: something very cool my oncologist said to me, was, "if you can take the energy
that your body has put into building these tumors, and have it for yourself again, aren't you going to feel great?" and her words eventually came true... but it took a lot longer than i really ever thought it would. "the human condition"" is a 26-part series about health and wellness. for more information on this program, and accompanying materials, call: or, visit us online at: